SALT LAKE CITY — Last February, Dutch cyclist Johannes Draaijer died of cardiac arrest a few days after a physician had declared him fit.
Questions surrounding his death linger in the Netherlands, where bicycles are as prominent as canals.
Draaijer, who finished 20th in last year's Tour de France, is the 15th competitive cyclist from the Netherlands to have died in three years, a statistic that has left medical experts perplexed.
Draaijer's death has become the catalyst for an official examination of the Netherlands' cycling program. The Royal Dutch Cycling Federation hopes to find clues to a mystery that has the international medical community's attention.
At the forefront are rumors that cyclists are using a genetically engineered kidney-disease drug to enhance performances. Some physicians are concerned that the drug, which the body also produces naturally as a hormone, is somehow linked to the deaths, but research does not indicate that.
The drug, erythropoietin (EPO), can be used as a simple alternative to what is known as blood doping. EPO stimulates red-blood cells to increase their output of oxygen-carrying hemoglobin.
The practice of blood doping involves the removal of two or three pints of blood about two months before competition, and freezing the red-blood cells. Before competition, the red-blood cells are thawed and injected into the system. The boost of red-blood cells increases oxygen supply to the muscles. Laboratory and field studies show gains in endurance of about 5% from this process.
Rob J. Pluijmers, a sportsmedicine doctor involved with Dutch cyclists for 15 years, admitted last week in Salt Lake City that he knows three professionals taking EPO, a recombinant hormone used to treat anemia. He refused to name the athletes, but this is the first official acknowledgement that athletes are using the drug.
Pluijmers, however, denied that any of the 15 deaths could be attributed to erythropoietin.
"There is no reason to think EPO use is involved," said Pluijmers who was visiting the United States to speak to colleagues at the American College of Sports Medicine.
Pluijmers said the cyclists he knows using the drug are from the Netherlands and Belgium. He said the three got the drug from sources in Belgium. One athlete, he said, was taking the drug to treat a medical problem, but the others were using it to enhance performance.
EPO is not yet registered in the Netherlands, although it is widely approved throughout Europe. The Food and Drug Administration approved its use in the United States last June. Amgen, a Thousand Oaks firm, developed the drug here.
Three years ago, physicians and pharmacologists stated their concerns about the abuse of erythropoietin among athletes such as cyclists and distance runners who would benefit from blood doping.
In October of 1989, Dr. Bjorn Ekblom of Stockholm's Institute of Gymnastics and Sport, reported that eight Swedish athletes increased their endurance by 10% after using erythropoietin during a study.
Ekblom, credited with discovering blood doping in 1972, said at the time: "This makes it hard to believe in sports' future."
Ekblom's skepticism is shared by many in the medical community who suspect widespread EPO abuse, although it may be years before they can prove it.
E. Randy Eichner, a professor of medicine at Oklahoma State University, said there is no way to differentiate between what the body produces and the synthetic drug.
Although banned by the International Olympic Committee, it is virtually impossible to detect. Researchers say that the injectable drug leaves the body within hours although the oxygen-rich red-blood cells remain for months.
The manufacturer of Epogen, the trademark name for EPO, has been asked to add a genetic marker, making detection possible in a drug test, said James C. Puffer, a U.S. Olympic Committee physician from UCLA. But Eichner said the industry is reluctant for fear of customer complaints over any alterations.
"This could make blood doping obsolete," said Connie Carpenter-Phinney, a 1984 Olympic gold medalist in cycling who was not involved in the U.S. cycling team's blood-doping scandal that became public after the Los Angeles Games.
The major concern with EPO is what effects it causes in high dosages. Physicians believe it can cause the blood to become so thick that the heart can no longer pump it. The result would be a heart attack, stroke or blood clot, doctors said.
The drug is considered safe when used properly, and research has not shown any link to sudden cardiac arrest. But as with early studies of anabolic steroids, researchers have not examined the drug's effects when taken in high dosages, as athletes might be likely to do.
Although doctors have no evidence of EPO use by U.S. athletes, the USOC's Puffer believes it is a problem.
"It is impossible to know, but I think it is one of our major concerns besides steroids," he said.